Cataract IOL Target Decision

[Luvtoski]

I know Targeting Plano is common and also my goal, but seeing the IOL Master results shows me that my Surgeon (and me) have a decision to make between an Alcon SN60WF that Targets either of the three following choices:
Target choices:
23.5 IOL with Refraction -0.1
24 IOL with Refraction -0.46
24.5 IOL with Refraction -0.82

I realize there is a 0.50 margin of error in targeting post-op uncorr. refraction, and was told one does NOT want to end up in the Hyperoptic (+) range.

Information that might help determine decision:  
1)  I am only doing my Left eye that had ERM peel Vitrectomy 9 month ago which induced this 3+ cataract.
2)  My right eye is GREAT, just a trace cataract and a +1...I will not do cataract surgery on this eye for many years.
3)  I am only 57, healthy and water and snow ski...don't mind wearing reading glasses.

Based on this information, which Target makes more sense to shoot for ?  Does previous Vitrectomy have any bearing on the decision, (IE does this possibly weaken the zonules, etc. so should I shoot for more of a Myoptic target ?) ?
Thank you !

[Ray T Oyakawa, MD]

The personalized surgeon A-constant is usually a different A-constant than the standard A-constant supplied the IOL company.  It is determined by putting the outcomes results from using that IOL in to a program.  I use Holladay Professional.  I believe it can be done with the IOL Master.  It results in a better outcome since it personalized for the surgeon's technique for cataract surgery.

Dr. O.

[Luvtoski]

Oops, I wasn't finished.

Different IOL Masters gave diff. results on the same AlconSN60WF IOL.

What is the personalized A constant, and would it show up on the IOL Master results of which I have a copy of. ?

[Luvtoski]

Thanks Dr. O.
I did ask my surgeon...got 3 different opinions from 3 different surgeons, so I feel the need to "plug in" my own opinion based on additional research.

I too was leaning in the 24.0D direction, as I always like a "happy medium". I also read that without the vitreous support that the Cataract surgery may cause the lens to sit further back than predicted, so one should over-compensate in the Myopic direction with Target.

#1) Is that correct...should we perhaps go further into the myopic area?

The margin of error of .50 is what I read was most normal to expect,
#2)  is that what you have found?

Different IOL Masters gave diff. results on the same Alcon Sn

[Ray T Oyakawa, MD]

You should ask your surgeon.  Is he using a personalized A constant?

Just from the numbers I would use 24.0D.  You will end up between +.04 to -0.96 from the margin of error your have given me.

Dr. O.